AANA Lab Course 913 - Advanced Knee Course-HTO_DFO vs. Arthroplasty_ Evidence-based Decision Making in the 35-55 Year-Old Faculty Lecture

HTO_DFO vs. Arthroplasty_ Evidence-based Decision Making in the 35-55 Year-Old Faculty Lecture_ Matthew J. Salzler, MD

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This presentation by Dr. Matthew Salzler at the 2019 AANA Knee Course reviews evidence comparing high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) versus unicompartmental knee arthroplasty (UKA) for treating medial compartment osteoarthritis (OA) in patients aged 35-55.<br /><br />Key questions addressed include which procedure offers better pain relief, function, durability, recovery, complication rates, and outcomes after conversion to total knee arthroplasty (TKA).<br /><br />Evidence levels are mainly observational (level III-V) with some systematic reviews. Data largely focus on medial OA treated with HTO or UKA, without differentiating HTO techniques or UKA bearing types.<br /><br />Cost-effectiveness studies suggest HTO is more cost-effective under age 60, while UKA is preferable over 60. Systematic reviews show both approaches provide good to excellent pain relief.<br /><br />Functionally, UKA patients generally achieve higher activity and functional scores (e.g., Tegner, Lysholm) earlier and at mid-term follow-up. Durability is similar: HTO survival about 80-85% at 10 years, UKA registry survival often in the low 90s percent, though revision characteristics differ.<br /><br />Recovery is typically faster after UKA, with immediate weight-bearing allowed, while HTO often requires 6 weeks of protected weight-bearing.<br /><br />Complications are more frequent with HTO (~25% minor to major issues including infection, hardware irritation, nonunion) compared to UKA (~6%, mainly dislocations and loosening).<br /><br />Conversion to TKA after either HTO or UKA yields comparable patient-reported and radiographic outcomes at mid-term follow-up. However, HTO to TKA conversions have higher complication rates, whereas UKA conversions involve longer operative times and more complex revisions.<br /><br />In summary, both HTO/DFO and UKA provide viable options for younger patients with medial knee OA. UKA may offer earlier functional gains and easier recovery. HTO carries higher complication risk but similar durability and potentially better function after TKA conversion. Decisions should consider patient age, activity level, joint alignment, and surgeon expertise, applying current best evidence for individualized care.

Keywords

high tibial osteotomy

distal femoral osteotomy

unicompartmental knee arthroplasty

medial compartment osteoarthritis

pain relief

functional outcomes

durability

recovery time

complication rates

total knee arthroplasty conversion